Women who are overweight and obese can find accessing healthcare difficult and stressful, according to research in the latest UK-based Journal of Advanced Nursing.

Researchers from Texas, USA, carried out in-depth interviews with women aged between 20 and 61, after recruiting them through local advertisements placed in community agencies and a regional newspaper.

"The participants in our study described the experience of seeking healthcare as a constant battle and struggle and were upset by the reactions of healthcare staff" says lead author Professor Emily Merrill from Texas Tech University Health Sciences Center.

"They told us that they felt even more uncomfortable with specialists than with their own family doctors and nurse practitioners."

Four themes emerged: struggling to fit in, feeling not quite human, being dismissed and refusing to give up.

Women talked about feeling shame and embarrassment because they did not fit into the normal healthcare environment because of their size and needed larger gowns, blood pressure cuffs, scales and chairs.

Elena told researchers that she had to wait half an hour to have her blood pressure taken, because the right equipment wasn't available. She related how embarrassed she was while the nurse was running round the office saying: "We need the bigger cuff. She can't fit the other."

And Tammy's bad experiences have made her plan ahead when she goes to a healthcare appointment. "I am to the point now where I will pretty much demand a larger fitting gown before the nurse even walks out of the room" she says.

Women also reported feeling less than human because of their size.

For example, the doctor delivering Doris' son upset her with a tactless remark at a time when she feeling particularly vulnerable because of her size. "He said 'Just relax and just envision yourself on a beach like a big ole whale beached.' That hurt me so much because already I felt big."

Tammy added that healthcare professionals didn't seem to see her as a person. "When you look at me, see me as you would look at any other normal person with a condition" she said. "Don't look at me as some huge overweight woman who needs your help."

The women who took part in the study had all dieted and felt defeated by their weight and their failed attempts to control it.

Stella said that being overweight was the "worst thing in my life" and she longed to be a normal size. "It's not something I think about one or two times a day. It's something that is always, always there, from getting out of bed..." she told researchers.

Elena was cross that the doctors didn't listen to what she said, that she didn't eat fast food and drink sodas. "They don't care. It's like they are too busy to stop and listen" she said.

The women also talked about being dismissed by healthcare professionals.

Lynette was refused treatment for her arthritis by a chiropractor because of her weight. She told the researchers he "took one look at me and said 'All you need to do is lose weight and that would solve all your problems'... He didn't bother with X-rays or an examination or anything, so it was amazing to me that he could know that from just reading over the questionnaire and looking at me."

And Kay's doctor was unsympathetic about her high blood pressure and weight problem and told her to simply stop eating. She felt that he had treated her "so pathetically like I was nothing" that she changed doctors and found one who treated her with respect. "He respected me, so I think I was more inclined to listen to him and to do what he asked me to do" she said.

"The eight women we spoke to were stigmatized because they did not fit into the healthcare environment or the cultural expectation of being slim" says Professor Merrill, who carried out the research with Professor Jane Grassley from Texas Women's University.

"It is vital that healthcare providers tackle the issues raised by overweight women as latest figures show that a third of women in the USA are obese. Research also shows that women may delay or avoid healthcare if providers have reacted negatively to them because of their weight.

"The women who took part in our study were determined to control their weight and improve their health despite many failed attempts. And they were keen to receive support and resources from healthcare professionals."

The researchers say that nurses can play a crucial role in supporting women who are overweight and obese, especially in primary care, and that training should reflect the growing need for effective care in this area.

"Nurses should also use their influence to adopt measures in all practice settings to provide appropriate communications, space, furniture, equipment and supplies to create a respectful and welcoming environment for patients who are overweight" concludes Professor Merrill.

Journal of Advanced Nursing is read by experienced nurses, midwives, health visitors and advanced nursing students in over 80 countries. It informs, educates, explores, debates and challenges the foundations of nursing health care knowledge and practice worldwide. Edited by Professor Alison Tierney, it is published 24 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. www.journalofadvancednursing.com

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